A couple of months ago I was included in a two day event designed to create a better vision for Australian healthcare, that is safer for patients and offers a more sustaining working environment for staff. I sat in a big tent with healthcare planners, policy makers, artists, musicians, politicians, medical students, playwrights, frontline healthcare staff and a handful of patient advocates, and together we went over what it means to try to make public health happen—in our hospitals, in our communities, in our selves.

It was a courageous, generous company of strangers encouraged to try new ideas and to listen well. The organisers brought in all the big contingencies for consideration: constraints, traditions, professional habits, new and emerging risks. I could see that the freewheeling schedule was occasionally stressful for outcome-oriented executives using departmental budget and time to be there. But when things are difficult, when the concrete is really set, new ideas have to be allowed to emerge without an agenda, and without immediate prospect of a fix.

Initially I wasn’t sure where the emphasis on kindness had come from, especially as we didn’t spend much time on what kindness might mean. This is important as there are specific interpretations of kindness that are built into different faiths and ethical systems, and there are other assumptions among those of us without faith. One interpretation that makes sense to me is etymological: in practising kindness, we are seeking to widen the circle of those whom we think of as kin. So while there’s a separate etymological case for connecting kindness to nature, the association with kin speaks of our capacity to overcome instinct, and to extend ourselves to the care of strangers as though they were among our own family and loved ones.

This means that kindness has something to do with both generosity and hospitality, two ideas I’ve been sitting with for a while. I suspect kindness practices may also be at the heart of ideas that Dave Cormier is discussing in relation to resilience, what Liz Morrish is writing about in relation to care, and the questions Viv Rolfe is asking in relation to corporate wellness programs that are emerging in universities as a response to academic stress. We’re seeing care for strangers all over the place: in political protest, in crowdfunding, and in the network itself.

Lea McInerney went to the Gathering of Kindness event on behalf of Australia’s health-focused Croakey website; she has just written a meticulous narrative of what we did over the two days. And here’s the thing: the event wasn’t originally intended to be about kindness at all, but was commissioned to attend to problems caused by bullying:

Around the same time, the Victorian Attorney-General’s Office had been conducting an audit of data from three reviews of bullying in healthcare settings. The findings were alarming – the incidence of bullying was high, it was poorly dealt with, many workers were caught up in an escalating cycle of poor behaviour, and they had little confidence that anything could be done about it.

This is why the event launched with a compelling piece of verbatim theatre, drawn from real critical incidents. Alan Hopgood’s play ‘Hear Me’ shows how staff in steeply hierarchical organisations create situations of escalating risk when they feel unsafe to speak out about what they see. When kindness in healthcare fails, it really fails.

At some level, this story should have been more unfamiliar to someone who works in a university. Critical incidents for us, even those that lead to protracted cases of grievance, rarely place lives at risk. I can enter the wrong grade in a spreadsheet, and no one dies. With our much lower stakes, surely we shouldn’t also see capable, productive professionals come to feel that they can’t continue to work?

And yet even though we aren’t mishandling medication or missing a diagnosis of disease, we are elevating the stresses involved in just doing our jobs by continually having to prove that we deserve these jobs at all. Far more than public health, public universities are tested by the entirely made-up demands of inter-institutional competition, to which our actual jobs are subordinated. Crucial to this is the ramping up of precarity, that pits us all as each other’s primary competitors for scarce resources and career survival. Liz Morrish says this:

In what seems like a perverse project designed to deprofessionalize, casualize and atomize the academy, community has been hard to maintain. Universities keep us marching along, forming and reforming in response to multiple restructurings, reviews and revalidations. There is a reason the word ‘tradition’ is rarely uttered in UK universities, except in the most elite. We are all newly precarious and we are not supposed to look for permanence.

The anxieties of precarity are intensified by conditions of continuous institutional self-review demanded by external accreditation cycles. So while being urged to focus only on productive work, we are also compelled into complex routines that we are know are only marginally productive. We jump through hoops and then design new hoops to jump through. Everything is urgent, and nothing can happen without three levels of committee review, and so this week’s emergency decision-making still won’t be implemented for two years, if at all. Meanwhile we go on chasing the relevance puppy all over the park.

But it’s OK because there’s a new building, a new brochure, a digital campaign that cost hundreds of thousands, and another consultant bustling out of the executive suite on the way to the bank. The hustle is on, a protracted and unreflexive confidence trick designed to persuade the market that we’re on the up. But inside, in confidence, we’re driven by the spectre of always-imminent downturns towards a weird brew of opportunism and thrift, that seems the only remedy for a kind of pervasive scarcity that no one can really account for. The contradictions between the brand and the budget seem significant. How did we end up committed to so much without resources in place? Why did we set things up to sustain only a few careers at the expense of so many others? Who is served by this?

And in these situations, small and harming critical encounters do happen, and cascade, and get escalated. Exhausted people entangled in the weeds of precarity fail to meet each other’s needs — not by much, not with much at stake, but enough to fire off an email that takes a tone, or to threaten some kind of something, if things aren’t fixed, things aren’t done properly, or as promised. Grievances rise up and are cajoled back into a kind of accommodation, for now. People don’t seem able to hear one another properly, to notice that the other humans around them are doing their best, that no one has enough of anything to do well what they came here to do.

This is really why I loved the Gathering of Kindness, because it was a sign that even entrenched and budget-driven problems can be thought about as capable of being changed. I loved seeing what our nearest kin in organisational terms—public health to our public education, two big engines of employment and hope in our local communities—are trying to transform about their culture. The event’s extraordinary organisers, entrepreneur Mary Freer and surgeon Catherine Crock, have a vision for change that is specific and achievable, and the commitment to make it work.

And so I really want to ask: if we could hope for an institutional vision of kindness as an essential component of higher education, what would that look like? How would students experience it? What would industry partners or government stakeholders notice us doing and saying if we had it? What would we be able to achieve with it, that we’re prevented from doing now by the conditions we’ve set for ourselves? What new opportunities in research or teaching would kindness itself generate?

What would we build, like that Oslo hospital, with the intention of making everyone feel good about being part of it?

6 Responses

Hear Me felt very familiar. We see the sloppiness every day. It’s almost a form of contempt that make a complete joke of the patient advocate office here and their efforts to fix the problem by getting the patient and the offending doctor together so the doctor can learn and improve. When that “solution” was offered I was speechless. This isn’t learning from mistakes, I’m not a test dummy or a practice scenario and to even imagine the “doctor” as capable… Well, you get it.

I like the idea of kindness and am even beginning to study Compassionate Listening but the concept of talking to medical people about caring is off my books.

I thought of you, Scott, as I was watching the full length of Hear Me performed at the Gathering of Kindness. It was a very confronting experience.

It seems completely OK to me that there are contexts in which practising kindness is a stretch too far because of something that you’ve experienced. I’m currently trying to write some feedback on a traumatic hospital admission experience, because I was asked to. And actually all that’s happening in my head is a sense of fatigue that it has to be written down. It feels like really hard work to point out the things that I would have hoped medical professionals might have thought about, just in human terms.

Kate, I get the fatigue thing. The protests of disbelief that “their” system failed–surely it must be my misunderstanding. The latest: “Well, that was at our branch clinic.” “But it was the oncologist HERE that cut me off just when I was sickest.” “Well, that wouldn’t have happened here.” “I wouldn’t know since when I asked to be transferred back HERE someone HERE refused the transfer.” “Well, who could that have been? We will certainly talk to them!” “Actually there was no one I knew of in charge of my case after my oncologist quit, it was just a decision without a name.” [….] and it just goes on…

There’s always the offer to hold someone responsible on the presumption that what feels like common practice is, when pointed out, a learning opportunity “that will benefit others.” Not you actually though and hurting the person back doesn’t seem like a solution anyway. For me, I can no longer explain into the void. I get angry and feel even more helpless, which tags me as “abusive and bullying” and then “uncooperative.”

As a way of fixing this the only solution is to slowly explain why they seem to have trouble helping me. That and show no emotion. A professional patient all the way.

I’ve been sitting on a half-finished post for a while that connects Google research into effective groups to Matt Bruenig’s firing from Demos, to trigger warnings, death threats, and hierarchy.

Maybe I’ll finish it. Your beautiful piece here has certainly inspired me. But to sum up, lack of psychological safety is a huge issue, and underlies both fatigue and institutional failure. People have to be able to say whatever comes out of their heads and expect a relatively charitable interpretation and an attentive response.

One of the things I’ve done in my work with our IT team here is to decrease the focus on the agenda in meetings. The agenda in meetings becomes a series of postures people take, and each one is exhausting for people — both talking and listening — because the dynamic of the agenda is one of control, and people don’t feel safe introducing new thoughts. We treat the agenda now as things we’d like to get to, and consult it when a gap occurs in the conversation.

So here’s a surprise — people leave these meetings now energized. They leave them jazzed about their job, and their co-workers.

Why? Because they were really listened to. They don’t spend the whole meeting looking for an appropriate place to insert their crucial concern, they just say it. When they say it, people don’t say — well, you’re off-topic. They respond. They try to emotionally engage in that person’s vision.

I think that we could add other elements to this. I think we do want to avoid exclusionary language, in order to create that safety. We want to facilitate to help the slower to interrupt. But we also want to make sure that when someone veers into saying something in the wrong words that we engage with their intent and not the politics of the language.

My new goal for meetings is at the end of each meeting people are better at holding conversations with one another than when they came in. They’ve learned how to read coworkers better, or accumulated some backstory that helps them understand their point of view. The agenda can go to hell if it gets in the way of that, because if we don’t leave the room as a better-functioning team we’re fucked anyway, because it’s only in the safe space that we will hear the voices and the perspectives that will ultimately make sure we are solving the right problems in the best ways possible. Priority one simply has to be to build your institution’s communicative capacity, and kindness (and safety) is the cornerstone of that effort.

Mike, I love this. There are many dimensions to it, but two jump out. First, charitableness — we just don’t hear enough about this, or think enough about what potential it offers us, but at first glance I’d say it’s exactly how kindness and hospitality might link. The knack to understanding hospitality is that it’s a particularly awkward reciprocity, harder to receive than to give, because it’s all about having the power over others, the resources to share in the first place.

So that gets me to the second thing you’re raising here which is how we come to allow ourselves to be persons with backstories in professional settings, not just technicians. I think this capacity to narrate a professional self in a way that’s not just driven by the routines of the resume is really what builds the strength of teams. Agendas themselves have a habit of addressing our technician selves, and they make the work of uncovering and sharing stories into a form of wasteful non-work, when in fact this is exactly how a team works to become itself.

This approach to meetings, this vision of people leaving more skilled in making conversation than when they came in, is a vision of teaching as a refusal of the many agendas of the syllabus and the curriculum.

The idea of being without backstories might be the key to why medical services seem incomplete. We as patients are dealing with people not as they are but in the incompleteness of their assigned role. People in perpetual tension.